4.2 of 63 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
Figures A and B are the radiographs of a 68-year-old man who is well known to you for having undergone a previous two stage revision for infection. He ambulates with a cane at all times and reports new-onset pain in his knee. An aspiration is performed and demonstrates a synovial WBC count of 26k. Which of the following risk factors is associated with failure of a second two-stage revision for prosthetic infection?
Preoperative synovial WBC >25k
Culture positive for an anaerobic cocci
Musculoskeletal Infection Society (MSIS) Type C host
Use of a semi-constrained prosthesis
Static, rather than dynamic spacer use
Select Answer to see Preferred Response
A 63-year-old patient presents with periprosthetic joint infection 3 years after primary total knee arthroplasty. A radiograph of her knee is seen in Figure A. She undergoes 2-stage revision total knee arthroplasty. Radiographs taken at the time of explantation are seen in Figure B. An articulating antibiotic spacer is placed. Two months later, she is deemed to be free of infection and is taken to the operating room for the second stage operation. Intraoperatively, it is noted that the collaterals are intact and the previous tibial tubercle osteotomy had healed. What is the most appropriate surgical strategy at this point?
Address epiphyseal defects with impaction particulate bone grafting
Address metaphyseal defects with structural allograft and uncemented, unstemmed implants
Address metaphyseal defects with uncemented, porous metaphyseal sleeves and uncemented, stemmed implants
Address diaphyseal defects with porous metal cones and uncemented, stemmed implants
Address diaphyseal defects with cemented stemmed implants
A 65-year-old man presents with aseptic loosening 3 years after total knee arthroplasty. The surgeon reviews radiographs of his knee and takes him to the operating room for revision total knee arthroplasty. During surgery, the exposure technique shown in Figure A is used. Which of the following radiographs (Figures B-F) has the greatest likelihood of needing this exposure technique?
An active 73-year-old male presents with progressive pain and instability 15 years after undergoing a left total knee arthroplasty. He denies any recent trauma. A comprehensive workup for infection is negative. What is the most appropriate management of this patient?
Protected weight bearing for 6 weeks
Revision total knee arthroplasty
Routine follow-up in 1 year
Polyethylene liner exchange and bone grafting
A 64-year-old female with rheumatoid arthritis is undergoing a left total knee arthroplasty. During the tibial cut, a ligament is transected by a reciprocating saw. The ligament is not able to be repaired. The surgeon is balancing the tibial and femoral cuts with sizing blocks and finds that the knee has valgus instability greater than 1cm in full extension. Which implant offers the most appropriate level of constraint while limiting the amount of implant-host interface stresses?
Unlinked constrained (varus-valgus constrained)
Fixed bearing PCL-substituting (posterior-stabilized)
Mobile bearing PCL-substituting (posterior-stabilized)
Compared to historical causes of revision after total knee replacement which of the following statements is most accurate?
Infection is now the most frequent cause for late revision
Polyethylene wear is no longer the major cause for revision
Aseptic loosening is now the most frequent cause for early revision
The percentage of revisions for instability and malalignment has increased
Stiffness is an uncommon reason for revision procedures
A 67-year-old female has elected to undergo total knee arthroplasty for degenerative arthritis. A pre-operative radiograph is provided in Figure A. Exposure to place the distal femoral cutting guide is difficult due to poor knee flexion following a standard medial parapatellar arthrotomy. Which of the following techniques will enhance the exposure without altering post-operative rehabilitation or clinical outcomes?
Complete release of the superficial and deep MCL
Extending the arthrotomy to an extensile rectus snip exposure
Converting to a mobile-bearing TKA design
A 71 year-old-male who underwent a primary total knee replacement in 1990 presents with right knee pain and instability for the past several months. Current images are shown in Figure A and Figure B. Which of the following is the most appropriate treatment at this time?
Revision of tibial component only
Management with a knee immobilizer for 3 months
Revision of tibial component with LCL reconstruction
Revision of tibial and femoral components with stems and/or augments
Revision of tibial and femoral components without stems and/or augments
Figure 25 shows the radiograph of an 84-year-old woman who has pain and is unable to extend her knee. History reveals that she underwent total knee arthroplasty 8 years ago. Aspiration and studies for infection are negative. During revision surgery, management of the tibial bone loss should consist of
reconstruction with a metal augmented revision tibial implant.
reconstruction with a hinged prosthesis.
reconstruction with a structural allograft.
reconstruction with iliac crest bone graft.
filling the defect with cement.
Figures 9a and 9b show the radiographs of a 75-year-old man who underwent a revision total knee arthroplasty with a long-stemmed tibial component. In rehabilitation, he reports fullness and tenderness in the proximal medial leg (at the knee). The strategy that would best limit this postoperative problem is use of
a base plate with an offset tibial stem attachment.
a bone ingrowth surface on the augment.
a nonstemmed tibial base plate.
allograft bone instead of metal augments.
bone cement to smooth the outline of the proximal medial tibia.
When compared to the standard medial parapatellar approach for revision total knee arthroplasties, the oblique rectus snip approach showed impairment in which of the following post-operative outcomes?
WOMAC function score
no difference in outcomes